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Statin Advisory: Definitions of Muscle Toxicity

This slide was created under the auspices of Professional Postgraduate Services® through an unrestricted educational grant.

  • Concerns were raised on the part of physicians and patients regarding the safety of HMG-CoA reductase inhibitors (ie, statins) after the withdrawal of cerivastatin from the US market in August 2001 as a result of increasingly frequent reports of severe and life-threatening rhabdomyolysis associated with the co-prescription of cerivastatin and gemfibrozil.
  • This prompted the American College of Cardiology (ACC), the American Heart Association (AHA), and the National Heart, Lung, and Blood Institute (NHLBI) to issue a Clinical Advisory summarizing the current understanding of statin use with regard to safety and providing updated recommendations for the appropriate use of these agents.
  • Because the general terminology to describe muscle toxicity in the medical literature is inconsistent, this advisory used terms according to the following definitions:

o        myopathy: a general term referring to any disease of muscles; myopathies can be acquired or inherited and can occur at birth or later in life

o        myalgia: muscle ache or weakness without creatine kinase (CK) elevation

o        myositis: muscle symptoms with increased CK levels 

o        rhabdomyolysis: muscle symptoms with marked CK elevation (greater than 10 times the upper limit of normal [ULN]) and creatinine elevation (usually with brown urine and urinary myoglobin).

Pasternak RC et al. J Am Coll Cardiol. 2002;40:568-573.
Pasternak RC et al. Circulation.
2002;106:1024-1028.